| NPI | 1376265504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 14200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 14200) |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2022-11-09 |